CAS Proposal Form

This form should be completed BEFORE beginning the experience.

Student Name: ___________________________________

Name of Experience: ______________________________

Experience Type(s): _______________________________

Dates of proposed experience: _______________________

Targeted Learning Outcomes:

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Brief description of the experience:

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What is the specific schedule for this commitment? Write the address if the experience
is off campus.

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Supervisor (optional):
Email:
Signature: